PRINE Vascular Access

PRINE Vascular Access Services:

Dialysis Access Management

AV Fistula Creation

AV (arteriovenous) fistulas are recognized as the preferred access method. To create a fistula, a vascular surgeon joins an artery and a vein together through anastomosis.

BAM info

Balloon angioplasty maturation is emerging as an important method to increase and improve function of autogenous arteriovenous hemodialysis access (AVF’s).

Fistulogram

These studies are performed to monitor the function of the fistula or graft. This is a diagnostic procedure done in the operating room by a specially trained, vascular/endovascular surgeon...

Peripheral Angioplasty

An angioplasty procedure is performed on the dialysis access site when the physician determines the decreased blood flow is caused by stenosis or narrowing of the vein.

Peripheral Arterial Stenting

The main indication for a stent is if the balloon angioplasty fails to achieve a satisfactory treatment of a narrowing or stenosis in the vein or adjacent artery if the vein is too weak, covered stents...

Thromboembolectomy

The thrombectomy procedure is performed to clear a blood clot that has formed at or near the dialysis access site. To DE-clot the access minimally invasive techniques are used.

Vessel Mapping

A Doppler study may be ordered before a fistula is placed to help the doctor evaluate the flow of blood through your veins and arteries.

Complete Catheter Services

Central Venous Access Placement Due to various medical factors some patients may need a catheter for dialysis during the interval period required to mature a...

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Thomas

Panetta, MD

Chief, PRINE Vascular Access.

Rafik

Moufid, MD

Vascular Surgeon

PRINE Vascular Locations

PRINE Vascular Access

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AV Fistula Creation

AV (arteriovenous) fistulas are recognized as the preferred access method. To create a fistula, a vascular surgeon joins an artery and a vein together through the anastomosis. Since this bypasses the capillaries, blood flows rapidly through the fistula. One can feel this by placing one's finger over a mature fistula. This is called feeling for "thrill" and produces a distinct 'buzzing' feeling over the fistula. One can also listen through a stethoscope for the sound of the blood "whooshing" through the fistula, a sound called a bruit.

Fistulas are usually created in the nondominant arm and may be situated on the hand (the 'snuffbox' fistula'), the forearm (usually a radiocephalic fistula, or so-called Brescia-Cimino fistula, in which the radial artery is anastomosed to the cephalic vein), or the elbow (usually a brachiocephalic fistula, where the brachial artery is anastomosed to the cephalic vein). We do a primary balloon angioplasty during the initial fistula creation which has been shown to greatly improve the maturation process time. A fistula will take a number of weeks to mature, on average perhaps 4–6 weeks. During treatment, two needles are inserted into the fistula, one to draw blood and one to return it.

The advantages of AV fistula use are lower infection rates, because no foreign material is involved in their formation, higher blood flow rates (which translates to more effective dialysis), and a lower incidence of thrombosis. The complications are few, but if a fistula has a very high blood flow and the vasculature that supplies the rest of the limb is poor, a steal syndrome can occur, where blood entering the limb is drawn into the fistula and returned to the general circulation without entering the limb's capillaries. This results in cold extremities of that limb, cramping pains, and, if severe, tissue damage.

One long-term complication of an AV fistula can be the development of an aneurysm, a bulging in the wall of the vein where it is weakened by the repeated insertion of needles over time. To a large extent, the risk of developing an aneurysm can be reduced by carefully rotating needle sites over the entire fistula, or using the "buttonhole"(constant site) technique. Aneurysms may necessitate corrective surgery and may shorten the useful life of a fistula. To prevent damage to the fistula and aneurysm or pseudoaneurysm formation, it is recommended that the needle be inserted at different points in a rotating fashion. Another approach is to cannulate the fistula with a blunted needle, in the same place. This is called a 'buttonhole' approach. Often two or three buttonhole places are available on a given fistula. This also can prolong fistula life and help prevent damage to the fistula.